4

Why?

I had my egg retrieval yesterday. Of 11 eggs that they retrieved, only 6 were mature and 5 of those six fertilized with ICSI and were frozen. The embryologist who called us today morning also informed us that 3 additional eggs matured overnight in the lab and that they would try to fertilize them today. I frankly do not have any hopes of those 3 even if they were to fertilize having scoured the web’s rather dismal statistics which predict very poor odds of these Day 2 ICSI’s making it to blast even, let alone turn out to be normal.

I don’t quite know how to describe what I am feeling right now. It’s almost as if there is a deluge of emotions knocking on my heart’s door but I have slammed the door shut on their collective faces. I feel like I am sinking, sinking deep down below into an abyss no one will ever be able to rescue me from. This cycle gave us so many heartaches, false alarms and yet despite all the catching up that my body did (with 14 follicles at last count) and despite the 11 eggs retrieved I am back to where I was with my first IVF with only 5 fertilized embryos. Which gives me a pretty darn good indication of what my chances of getting a chromosomally normal embryo would be like.

Yesterday, right after retrieval, when the embryologist came over to let us know our count, he also insisted we tell him right there and then whether or not we planned to go in for egg banking. K and I had spoken extensively about this and we were more or less decided that whatever the numbers we would bank just to give us the best odds possible. For, if these two cycles at CCRM do not give me a take home baby I have low hopes it will ever happen with my own eggs. Still, we were told we would have to take that call when we got the fertilization report from the embryologist the day after retrieval. Not like 20 minutes after coming out of anesthesia. That’s what we had been led to believe and the plan was that we would take Thursday evening to flesh out the issue and have a definite answer for when the call came on Friday. This pissed me off. What pissed me off further is when the embryologist (a really nice man) told me that with 11 eggs Dr Schoolcraft recommends egg banking. Which I found a ridiculous notion. If 11 implies egg banking then at what stage should one just proceed with the one cycle?? When you make like 20 eggs? 30? Isn’t that typically a PCOS thing and does not that typically imply poor egg quality? Where the heck were these numbers coming from? Dr S (Surrey) had told us that anything below 5 and he would strongly recommend banking. But of course he was talking about fertilized embryos. How were we to know that even with 11 bloody eggs we would only make 5 embryos!!! What. the. f—k.

As soon as K hung up with the embryologist, I felt the familiar mist of panic envelop me, pulling me down faster than I could escape it. I was choking, sobbing, heaving all at the same time. He tried to reassure me telling me that there were three more that could potentially fertilize by tomorrow but to my mind those were probably not good quality considering they did not come out mature from my body.

So, after 40+ injections, 7 blood tests, 9 ultrasounds, 1 egg retrieval, many sleepless nights and countless hours spent stressing what do we have to show for our big gamble on CCRM? The same results we got from our local clinic. And way more heartache.

I’m sitting at the airport right now, waiting to check in for our late night flight. We got here way early because we had to drop the car off. K is as crushed as I am and he is coping the only way he knows to –dissolving himself in his work. As for me, I look around the hordes of people here with little babies, toddlers, strollers and the odd pregnant belly and I want to set the world on fire. I am so angry. So furious.

I spoke with my mom earlier today. She was sad to hear what happened but tried her best to assure me things will work out. I am afraid I could not believe her words today. I was despondent, angry and immensely frustrated. I feel God keeps abandoning me in my time of need. I call out to him day upon day, beg him to give me this one thing, keep accepting all the trials that mark this journey with as much stoicism as I can muster. But does he listen? Does he give me any reprieve? No.

I don’t know where to go from here. I know I have to do this again and I also know that next time around this could go either way. My body keeps tricking me into believing that it will do great yet falters in the end each time. I know I will somehow have to brush off the dust and get myself up and going again. But right now that seems to painful to even envision, let alone execute. I know there are others like me, some in positions worse than mine who do not let this heartless disease sap them of their spirits. I admire them wholeheartedly. But I admit I am not so strong. Or perhaps I do not want to be anymore.

This is just so difficult.

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CCRM days 3 & 4 (CD 8 & 9)

I can’t quite say how I expected things to turn out here at CCRM but so far it’s been a pretty action-packed few days. Today was my 9th day of stimming and I’m tiring of things. I haven’t been sleeping well (at all!) and however much I try I’m unable to nap through the day. That couple with the constant poking (stims + bloodwork) and prodding (ultrasounds) has left me pretty darn tired. Strangely though, this hasn’t resulted in my shifting into instant bitch-mode; instead I remain fairly calm about things. Even hopeful!

So without further ado, here are the numbers from the past two days:

Day 8

LO: 18.5, 13, 12.2, 9, 7, 6.6, 5

RO: 16.7, 14.6, 12.2, 6.2, 6

E2: 1369

Day 9

LO: 18.2, 14, 14, 11, 10, 9

RO: 18.5, 14.3, 12.2, 9.3, 6, 6

E2: 1928

So, it seems that things are moving along very slowly indeed. The good thing is that the bigger follies are all a similar size but then a couple of them seem to have actually shrunk a teeny bit which, of course, worries me greatly. The nurses at CCRM, while extremely kind, are all reserved in their opinion of how things are progressing and it being a weekend I could not get Dr S’s opinion on the matter.

All I know is that for now, I’ve been told to continue with my stims for tonight and tomorrow morning and then go back to CCRM at 7 am (!!) for another monitoring appointment. As soon as we get done with the u/s and the bloodwork there, we have to rush to Denver to get another dose of cetrotide from a local pharmacy here ’cause I’m out of it. I asked the nurse today if I would need other stims as well but she said we wouldn’t know till my appointment tomorrow. So we reach the pharmacy, get the cetrotide, finish the injections and then drive back (fast!) to CCRM for my IVF physical appointment. Once we’re done with that we need to check out of this hotel and (they did not have rooms available here starting tomorrow for the next few days) and hang out somewhere till its time to check into the other hotel. Oh and, in between, we have to go back to CCRM yet again so that hubby can do his thing for the backup freeze. Whew! It’s going to be a long, long day.

While I am tiring of the shots, I do want to give all my follies the chance to mature and make beautiful eggs for which I welcome the opportunity to stim extra if needed. I’m praying hard and staying hopeful for what lies ahead.

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CCRM days 1 & 2 (contd.)

… which brings us to today i.e. day 2 @ CCRM (CD 7)

I woke up feeling somewhat refreshed and hopeful. Our only appointment today was a regroup with Dr S. K and I had already been through the questions we wanted to ask him, of topmost priority being his opinion of how I was responding and how he sees this cycle shaping up. We also wanted to discuss embryo banking with him. If you remember, we had brought up this question in our initial consult and in our post OWDU regroup and both times he had suggested we wait on the day of ER for if we make anything above 6 he would not think we need to bank. We wanted to know if his opinion had changed since then.

Owing to a time crunch, lunch today also was at the food court. I had a plate of falafel, tabouli and chicken shawarma from the mediterranean grill while K had some chinese. We checked into CCRM for our appointment and prepared to wait in the lobby. We were called in soon after and seated in a consulting room. That’s when I started feeling really nervous. We had not spoken with the doctor ever since we started this cycle which, if you count the pre-priming and the priming part was over a month long already. I was anxious to hear what he had to say about my chances. I didn’t have to wait for long though; he walked in soon enough and after exchanging some pleasantries it was down to business.

Well, he said, there is good news and bad news. My stomach lurched uncomfortably as my mind got stuck on the ‘bad news’ bit. He said he was happy that the follicles were all a similar size but yes, he was surprised by how little he saw. He did not hold out major hopes for the 9 and the 7 to catch up so, in his estimation, we would be looking at 5 eggs at retrieval. My heart clenched at those words. 5 eggs retrieved would mean at best, if we were ridiculously lucky, 5 mature and 5 fertilized. This was worse than my first cycle where we had 7 retrieved.

We discussed embryo banking which now he was wholeheartedly recommending. He emphasized the financial implications of banking but even though K & I had already discussed it before, all I could think in my heart was I would not be pregnant this year either. Another effin’ year gone by and I am still not pregnant. I tried hard to ignore my mounting frustration and pay attention to what Dr S was saying. He suggested a regroup after retrieval to discuss our next steps esp. what protocol I should be following for the next round. He said we could add in clomid to the cocktail I am taking right now to try kickstart my recalcitrant ovaries into action. If all went well, I would be back here in early January for my second retrieval. Wonderful.

It all seems so damn ambiguous, even this IVF thing. We thought we were covering our bases by going to the best -CCRM. But there is no guarantee ever, is there? Even with some really good test results and a consistent AFC of 13, I seem to be a poor responder and that makes me very angry. I am trying hard not to resent my body for all this but its tough. I see pregnant women everywhere and its hard not to let my bitchy self get the better of me and think ‘oh all you probably needed was some red wine and some mood lighting’. I want so badly to have my own bump, to feel my belly swelling, to hold a tiny little person in my aching arms and to complain of sleepless nights…

Ever since we got back from the appointment I have been quiet as my mind churns in anguish. My darling love, my husband, my best friend is doing such a great job taking care of me yet letting me be. We had planned to go somewhere today, a short trip somewhere close by. But after the meeting, I felt so glum I did not feel like appreciating the natural beauty that surrounds me (and there is SO much of that here in Colorado!). I hate feeling like this. I hate this sadness, this uncertainty getting the better of me to an extent that I am unable to function normally and all I can do is stare into space, trying to calm the noisy chatter in my mind and quell the rising despair in my heart.

I want so badly to believe that there is a happy ending after all this. I want to have faith and I want to feel happy and light with the knowledge that my baby is on its way to me. But I feel immensely tired and sad and just plain bleak. Let’s see what tomorrow’s monitoring brings.

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Yellow, not green!

We finally had our much anticipated regroup with Dr S today. It went by pretty quick and was sort of anti-climactical. I mean I obviously knew, basis the test results, what he was likely to say but somewhere our last failure has left me so wary I was prepared for the worst.

He started by discussing our test results and I believe he mentioned the word ‘good’ when describing my ovarian reserve even though my FSH is borderline high (10.3) and my AMH is below what they consider normal for my age at about 1.4-1.5 (mine’s 1.3). APA testing revealed only one slight elevation on the IgM (mine was 13, normal’s <11) so he said I did not need any blood thinners (interestingly this is something he told us on our first phone consult itself without any testing!)… phew! Uterine x-ray showed an AFC of 13 and normal blood flow to ovaries all of which is good. DH’s numbers also look good with his motility at 55% even though morphology is low at 2% (he did remind us that they use very strict criteria so, with 4% being the normal, this wasn’t too shabby). His sperm DNA fragmentation results will still take another week or so to come in.

So, he is sticking with his earlier prognosis and his recommended protocol for me is

****drumroll****

EPP–Estrogen Priming Protocol

He also wants to add in a growth hormone (saizen??) and probably an antagonist to prevent premature ovulation. He thinks we should wait on taking a call whether to do embryo banking or not depending on how the ER goes. Anything above 6 eggs and we should not need to bank, according to him.

We asked him a few questions which he patiently answered. He will be using a double trigger for me (HCG/ Lupron) and closely monitoring estrogen levels even though I am unlikely to hyperstimulate. When I asked him how I can improve egg quality he asked me if I was taking the supplements prescribed by them and I said no, I am taking then of my own accord. He told me to ask my nurse for a list and then hung up with the promise that a nurse would contact us soon to discuss scheduling.

So, from the above, it would seem that this went pretty well, right? Well, perhaps its the exhaustion from last evening’s yoga class but truth is, I don’t feel too spirited somehow. Perhaps because I am still, somewhere in the back of my mind, coming from a DE perspective whereas he was pretty clear right from the get go that I should try again with my own eggs. Perhaps because I was anticipating getting rejected by them basis my AMH (which had been much lower at 0.48) and my FSH (which I had never tested before). Or perhaps because I just don’t trust my luck anymore! I kept asking K whether he thought we’re in and he said of course silly girl, this is it; we will be cycling at CCRM.

Really?

All I could think about was one strange comment Dr S made–something about this being a yellow light, as opposed to a red one. Why not green, my mind asked? I categorically asked him if there was any further testing to be done or any issues to resolve before we could start and he said no, it all looks good. Then why yellow? K reasoned with me saying that he is probably meant that about the whole process, especially since we made no chromosomally normal embryos last time. He’s probably right. Perhaps I am just being silly and over-thinking things (surprise surprise!).

The nurse is yet to call. I hope she gets in touch with us soon. I need to see my calendar to believe this is real!

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Tick tock…

It’s been a good weekend. Yesterday was shopping at the farmers market followed by BBQ at my brother’s place in the evening and today was seafood lunch with friends, grocery shopping and a saunter through the mall. Tried my hand at making some Thai gai pad krapow but it didn’t quite tickle the taste-buds as much as the restaurant version usually does! Oh well, next time maybe.

We’re both feeling a bit on edge, though, with our regroup appointment with Dr S coming up on Tuesday. I am anxious to know what he has to say (there should be absolutely no reason why they would not let us try with our own eggs but I want to hear it from him) and also when we can start. There’s a part of me that is undeniably excited and hopeful that things will work out this time and yet there’s another part that is quite simply terrified. This whole IVF process is so fraught with the fragility that hope instills in us -hanging on to every day all the time hoping, hoping, hoping that things will turn out right. The hope that there will be enough follicles, that they will mature at the right pace, that  they will result in mature eggs which will all hopefully fertilize and that finally they will create perfect day 5 blasts that will be chromosomally normal. It’s a crazy roller coaster and the cocktail of hormones just makes the ride that much more precipitous.

Plus, this time there will also be the additional stress of travel which I am quite nervous about. It was another thing to get injected in the secure confines of my home while sticking to my daily routine and it will be quite a different matter, altogether, to do the same thing in a hotel room in Colorado with nothing really to distract us! Anyhow, fact is I am grateful to have a chance to cycle at CCRM and I’m going to keep that in mind anytime I feel the stress levels begin to rise.

Fingers crossed for Tuesday!

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CCRM test results

As I return to cyberspace after a long hiatus, there is so much to write about… bear with me as I attempt to fit in the chaos of last month in my next few posts all of which are in danger of being regurgitated today itself (don’t say I didn’t warn ya!).

As if the battery of tests I got done at Zouves’ wasn’t enough, CCRM graciously offered some more to add to the merry cocktail. Some of these (AMH, hubby’d SA) were repeats which they just prefer to get done at their lab while others (amazingly enough!) like the hysterectoscopy, day 3 bloods etc. had not been done before. Also, for all patients above the wonderful age of 35 (which already seems so far behind… sigh!)… they require a baseline mammogram… just in case you’re not wrung out from all the poking, prodding and accompanying stress, here’s a little something more to add to your overflowing cup of joy 🙂

Everything went off smoothly. The mammogram did cause me some anxiety (and not for the procedure itself which turned out to be merely uncomfortable and not hugely painful as I had feared) as the lab tech told me I had dense breast tissue and should not be alarmed were I to be called back for additional testing. Apparently, roughly 50% women have this condition and it makes it difficult to detect things on a routine mammogram. Obviously not thrilled at this revelation, I spent the next week freaking out every time the phone would buzz, convinced that I would be called in but it never did happen! Oh and the whole shipping thing with the day 3 bloods was a little nerve-wracking (esp. since I got my period over a weekend and there are strict missives from HQ to NOT ship blood over weekend) but the local Quest lab stepped up to the task and everything worked out just fine. In fact, the day CCRM received the bloods is the same day they tested and called with the results which I thought was pretty awesome!

So, here are the numbers:

AMH: 1.3 (previously 0.48… yippee!)

FSH: 10.3

Estradiol: 65 (could be artificially suppressing FSH)

LH: 6

AFC: 13 (stayed the same from March testing)

Mammogram: normal (whew!)

Antibodies: only 1 slightly elevated, all other normal

DH SA: Motility back up to 54% (yayy!), Morphology: 2%

Karotype testing for both of us: normal

Genetic panel testing: one indeterminate value for DH (beta thalassemia). However, since I am not a carrier, chances of our baby being affected vlow/ nonexistent)

TSH: bounced from 2.7 back to 2.3 (the first one might have been high cause I skipped my meds a couple days before OWDU. However OB advised upping Levothyroxine dosage to 50mcg from 25mcg. Here’s hoping I don’t lose more weight!)

Phew!

So overall, things are definitely looking up from last time when it seemed to be all doom and gloom. I was ridiculously excited at my AMH going up (even though I get that different labs might yield different results) and more than a little pissed off at Dr Z for stubbornly maintaining that AMH cannot go up! I think the surgery, continued Vit D, acupuncture etc. may have all contributed. Of course, it’s possible that the first result was a freak incident.

The FSH number does concern me. I know it’s borderline (CCRM prefers it to be under 10) but with the high estradiol, the nurse said it’s more likely 11 or 11.5 (not hideously bad but not great either). I’m hoping, praying, begging that my egg quality is not affected.

For now, though, I am going to be happy with these results (which are some of the best I have had ever since we started TTC) and await our next consult with Dr S on Sept. 10.

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OWDU @ CCRM

This should’ve been posted about a month ago but I’ve been in a different mind-space altogether and I suppose ignoring this blog was my way of ignoring everything TTC-related! 

(Aug 7, 2013)

Soooo… we had our initial phone consult with CCRM’s Dr. Surrey (who, btw, is super nice to talk to); he seemed pretty positive about things and asked us to schedule a One Day Work Up, which is their standard procedure. This was on Friday, the 2nd and as luck would have it, I was at the right time in my cycle and a cancellation came through so before we could say ‘Baby’, we were on a plane from California to Colorado!

We took the clinic’s advice to fly out a day before (the appointments began at 645am the next day!) and stayed at the Townplace Suites, a few miles away from CCRM (thanks to them, got a great discounted rate as well!). I’ve been to CO before (accompanied the spouse on a work trip to Vail last year) and I find it breathtakingly pretty. Lonetree, where CCRM is located, is a lovely place with some seriously huge houses, wide roads and lots of sky! While we didn’t have time to saunter about and explore, we managed to squeeze in a trip to the nearby mall (the whole place had wooden floors!!)

Next day, bright and early, we walked over to the reception, checked in and picked up a copy of our schedule. It was quite like the first day of grad school, complete with multiple back to back sessions, orientations and power-points and lots of sizing up strangers! Overall, I would say that the entire affair was extremely well organized, we never waited for longer than ten minutes and everyone was nice and courteous. The only minor complaint I have is about the food; they have a little kiosk that sells sandwiches and stuff as well as some basic beverages (they even provide ten dollar coupons for the same) but it opened late and there was nothing gluten or dairy free that they offered (actually, come to think of it, CCRM doesn’t seem to be a big believer in altering diet–no mention of gluten, dairy whatsoever!). Anyhow, we did get a lunch break of sorts which we used to hop over to a nearby strip mall and chomp on some delish Vietnamese food.

So, back to the OWDU. Basically, it takes you through every possible aspect of the IVF journey at CCRM and provides you with a LOT of information regarding IVF itself as a process. For folks new to the IVF world, there was a great presentation that explained the female biological makeup and how IVF works by controlling hormonal response etc. We found it a little painful to sit through mostly because we were well acquainted with all the info and well–we were starving! But we both agreed that this was probably one of the more comprehensive explanations we had come across and perhaps we would have appreciated it more earlier in our IVF journey.

The rest of the day was a blur of testing, nurse consultation, business office and lab consults etc. An ultrasound for me revealed a normal uterine cavity, an AFC of 13 and good blood flow to the uterus. I was especially happy about the latter because I routinely suffer from cold feet (literally, I mean!) and my acupuncturist has been concerned about uterine blood flow. A hysteroscopy conducted by Dr S himself revealed no abnormalities or inflammation. He was great to meet with, just the right combination of professionalism and a laid-back, friendly demeanor. He told us he was optimistic about our chances and while we had a plethora of more testing to do, he hoped things would work out well.

Another few consultations and 11 vials of blood later (6 for the spouse), we were free to go. We walked out, exhausted and just about managed to make it back to the hotel and crashed! Two hours of a much needed nap later, we were both feeling half-human again. Over a nice sushi dinner, we discussed the day and concluded, cautiously, that it had been a reasonable success and that hopefully CCRM would give us the green flag to try with our own eggs!